2012-04-25

Opinions on the New CDC Numbers of Autism Diagnoses



Eric Fombonne on a "real increase on prevalence":
This interpretation is only one of many. My approach has been to look at these data and systematically examine how alternative explanations could explain these trends. The idea that the incidence is increasing should only be accepted if alternative explanations can confidently be ruled out. Differences in ascertainment (the ability to identify cases in surveys) and diagnostic concepts and criteria are still significant issues. 
Some states use only medical records, others use both medical and educational records. If next time all states include educational sources, the rates will go up, not because of an increased incidence but because the method will be more efficient at identifying cases. 
 I noted some methodological  peculiarities in the survey methods employed in the two states with the highest rates. 


Association for Science in Autism Treatment: In response to a newspaper article (http://asatonline.org/media_watches/79)

"Further, there have been a number of studies looking at the impact of changing diagnostic criteria and diagnostic substitution on the prevalence rates of autism. Those studies have shown that there is a relationship between diagnostic practice and prevalence rates; a large portion of the increase remains unexplained.  In studies investigating this relationship, less than a third of the observed increase in prevalence of autism can be attributed to changes in diagnostic practice(Coo, et al., 2008; King & Bearman, 2009)."


Dr. Allen Frances:
The most direct opinion I have seen. On the reasons for the increase in autism diagnoses to 1 in 88 children:
Having the label can make the difference between being closely attended to in a class of four versus being lost in a class of 40. Kids who need special attention can often get it only if they are labeled autistic.
So the autism tent has been stretched to accommodate a wide variety of difficult learning, behavioral and social problems that certainly deserve help — but aren’t really autism. Probably as many as half of the kids labeled autistic wouldn’t really meet the DSM IV criteria if these were applied carefully.
Freeing autism from its too tight coupling with service provision would bring down its rates and end the “epidemic.” But that doesn’t mean that school services should also be reduced. The mislabeled problems are serious in their own right, and call out for help. 
So where do we stand, and what should we do? I am for a more careful and restricted diagnosis of autism that isn’t driven by service requirements. I am also for kids getting the school services they need.
The only way to achieve both goals is to reduce the inordinate power of the diagnosis of autism in determining who gets what educational service. Psychiatric diagnosis is devised for use in clinical settings, not educational ones. It may help contribute to educational decisions but should not determine them.


Increasingly panicked, parents have become understandably vulnerable to quackery and conspiracy theories. The worst result has been a reluctance to vaccinate kids because of the thoroughly disproved and discredited suggestion that the shots can somehow cause autism.

Dr. Allen Frances, now a professor emeritus at Duke University’s department of psychology, chaired the DSM IV task force.


http://www.nypost.com/p/news/opinion/opedcolumnists/america_false_autism_epidemic_jfI7XORH94IcUB795b6f7L#ixzz1t5ReetDW




Roy Richard Grinker
Unstrange Minds documents Grinker's quest to find out why autism is so much more common today, and to uncover the implications of the increase. His search took him to Africa, India, and East Asia, to the National Institutes of Mental Health, and to the mountains of Appalachia. What he discovered is both surprising and controversial: There is no true increase in autism. Grinker shows that the identification and treatment of autism depends on culture just as much as on science. As more and more cases of autism are documented, doctors are describing the disorder better, school systems are coding it better--and children are benefiting. Filled with moving stories and informed by the latest science, Unstrange Minds is unlike any other book on autism. It is a powerful testament to a father's quest for the truth, and is urgently relevant to anyone whose life is touched by one of history's most puzzling disorders. 

Deborah Bilder, Utah University researcher


"I’m not convinced yet this is truly an epidemic," she said. "Rather, we are much more aware of it. We identify it in much more higher-functioning folks than we recognized before. (...) The modern criteria have expanded the number of folks who are included in this diagnosis."